Payor Disputes
Disputes with private insurers, Medicare Advantage plans, and Medicaid MCOs over claim denials and recoupments.
UPIC Record Requests: How Many Charts Is Normal
A UPIC records request for ten claims signals a probe. Thirty or more usually means the contractor is building toward extrapolatio…
What a UPIC Audit Costs Even When You Win
Prepayment review, professional fees, and lost time build up over a UPIC audit's full timeline, whether or not the provider is ult…
UPIC Education Letters: A Warning Worth Heeding
A UPIC education letter is the audit's most lenient outcome, not a clearance, and it signals remediation physicians should not ski…
UPIC Audits of Telehealth Providers
UPICs mine telehealth claims for volume outliers, then test platform prescribing and encounter documentation against Medicare's te…
UPIC Audits and Your Medicare Enrollment Status
UPIC audit findings can trigger Medicare payment suspension, deactivation, or revocation, with a reenrollment bar that runs for ye…
UPIC Audits of Pharmacies Under Part D
UPICs review Part B and Medicaid pharmacy claims, not Part D. Here is how the two audit tracks overlap through prescriber pattern…
UPIC Audit Defense Timeline: Notice to Resolution
Each stage of a UPIC audit, the 30-day records request, the review period, and the five-level Medicare appeal, with realistic dura…
Employee Interviews During a UPIC Investigation
UPIC investigators routinely interview practice staff, and an informal answer can trigger federal exposure under 18 U.S.C. Section…
Document Preservation When a UPIC Audit Opens
A UPIC audit notice starts the preservation clock on EHR audit trails, signature logs, and adjudication records well before any la…